The Annals of thoracic surgery
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Infants supported by extracorporeal membrane oxygenation (ECMO) after a Norwood operation face in-hospital mortality rates of 60% to 70%. There are limited data on completion of staged palliation for the subset of patients who survive to hospital discharge. ⋯ Extracorporeal membrane oxygenation after a Norwood operation can be life-saving but ultimate survival through staged palliation remains suboptimal. The elevated mortality risk for patients supported by ECMO persists after hospital discharge. Both socioeconomic factors and ECMO-related morbidity may contribute to midterm mortality.
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Despite modern advances in surgical care, triple-valve surgery (TVS) remains a challenge and carries a mortality of 10% to 20%. No validated risk score is available for TVS, and the effect of advanced age is unknown. This study examined our results in the modern era with the aim of identifying perioperative predictors of adverse outcomes. ⋯ TVS remains a surgical challenge in the modern era. Despite a trend of increasing age and surgical risk, the early mortality rate and long-term survival remain respectable. Advanced age is associated with increased perioperative risk, but age per se should not be a contraindication for TVS.
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Forty-four percent of patients with pathologic node negative (pN0) non-small cell lung cancer (NSCLC) die within 5 years of curative-intent surgical procedures. Heterogeneity in pathologic nodal examination practice raises concerns about the accuracy of nodal staging in these patients. We hypothesized a reciprocal relationship between the number of lymph nodes examined and the probability of missed lymph node metastasis and sought to identify the number of lymph nodes associated with the lowest mortality risk in pN0 NSCLC. ⋯ Lymph node evaluation falls far short of optimal in patients with resected pN0 NSCLC, raising the odds of underestimation of long-term mortality risk and failure to identify candidates for postoperative adjuvant therapy. This represents a major quality gap for which corrective intervention is warranted.